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<br />PERMITI,EE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Holnam, Iuc. - Ft Collins Plant <br />M-1977-345 <br />Boettcher Sandstone Quarry <br />October 10, 2002 <br />1 <br />RECE9VED <br />OCT 0 8 2002 <br />Givision of Minerals and Geology <br />$281.00 (Due on or before your anniversary date) <br />Larimer <br />According to C.R.S. 34-32.5-1 1 6 or C.R.S. 34-32-1 16, each year, on the anniversary date of the permit, an operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, reclamation <br />accomplished to date and during the preceding year, new disturbances that are anticipated to occur during the <br />upcoming yeaz, reclamation that will be performed during the coming year, the dates for the beginning of active <br />operations, and the date active operations ceased for the yeaz, if any. <br />Please attach Your revised written annual resort and annual report maa to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary changes: <br />Permittee Contact: Britney Guggisberg <br />Permittee Name: Holnam, Inc. - Ft Collins Plant <br />Address: P.O. Box 1548 <br />LaPorte, CO 80535 <br />Phone Number: (970) 482-4065 <br />Fax Number: (970) 482-1363 <br />Roy L. Stienmier <br />Holcim (US) Inc. <br />P.O. Box 1468 <br />LaPorte, CO 80535 <br />(970) 482-5600 <br />(970) 482-5608 <br />If you have additional comments and/or information that should be provided to the Division, please provide it below <br />or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />Srgnature of Corporate Officer, Owner, or Desrgnee <br />Date <br />